Digital mole monitoring
| Subchapter(s): |
Short Term Monitoring
Long Term Monitoring
Basic principle of digital dermoscopes
A hand-held dermatoscopeThis traditionally consists of a magnifier (typically x10), a non-polarised light source, a transparent plate and a liquid medium between the instrument and the skin, and allows inspection of skin lesions unobstructed by skin surface reflections. Modern dermatoscopes dispense with the use of liquid medium and instead use polarised light to cancel out skin surface reflections. is attached to a digital video cameraA camera is an optical instrument for recording or capturing images, which may be stored locally, transmitted to another location, or both. The images may be individual still photographs or sequences of images constituting videos or movies. The camera is connected to a monitor, that displays the dermoscopic image in real time. A computer allows to capture and storage the images from the camera.
Digital dermoscopyDermoscopy using digital images. This is used for telemedicine and monitoring. can improve diagnostic sensitivity for early melanomaThis glossary term has not yet been described. by identifying changes in lesions over time that indicate impending or incipient malignancy and it can reduce the number of biopsies of benignis any condition that is harmless in the long run lesions that are biologically indolent (senescent, not changing).
Benefits of digital mole monitoringTaking sequential images of pigmentes lesions in order to be able to evaluate change over time.
- Simpler monitoring of lesions
- Images of the same lesion obtained at different points are easy to compare
- Enables to diagnose small, inconspicuous and featureless melanomas by detecting change over time
- Helpful for high risk individuals with multiple pigmented lesions
- Patient participation in the examination
Indications and contraindications
- Digital monitoring should be reserved for small and flat melanocyticThis glossary term has not yet been described. lesions, that demonstrate no obvious cluesEvidence, in an investigation to melanoma.
- Regardless of how one uses monitoring, knowing which lesions are unsafe to monitor is essential. Monitoring is performed on potential melanomas.
- Monitoring by digital monitoring is especially suitable for patients with multiple neviThis glossary term has not yet been described.. For these high risk patients, lesions to be monitored are selected randomly. It is recommended to evaluate and re-image as many lesions as possible at each consultation.
- When examining patients with multiple nevi, it is recommended to dispense with the documentation of melanocytic lesions that are smaller than 3mm in diameter.
- Nodular melanomas can grow rapidly even in the early stages of evolutionis change in the heritable characteristics of biological populations over successive generations. Nodular lesions that cannot be diagnosed as benign with absolute certainty must be excised at the initial consultation.
Interpretation of changes
Distinctions are made on the basis of changes in size, colorColor (American English) or colour (Commonwealth English) is the characteristic of human visual perception described through color categories, with names such as red, yellow, purple, or blue. and structure.
Changes in size
- Symmetrical: the shape of the lesions remains the same
- Asymmetrical: tha shape changes
Changes in color
- A pre-existing color (usually brown) appears lighter or darker
- A new color is seen
Changes in structure
- Disappearance of an existing pattern
- Appearance of a new pattern
- Presence of basic elements of a pattern in greater or reduced numbers (such as dots or clods)
Short Term Monitoring 
every three months or less
Is performed for lesions, that because of history of appearance, cannot be deemed benign with absolute certainty at the initial examination
Long Term Monitoring 
every six months to one year
Is mainly used for randomly selected lesions with no features to suggest malignancy, typically in patients with multiple nevi
Growing nevus or melanoma?
- NeviThis glossary term has not yet been described. stop growing at some time whereas melanomas do not.
- In adults, the proportion of nevi that show significant changes in the course of a year is less than 5%.
- Changes in color almost never occur in nevi. Significant structural changes are mainly observed in melanoma.
- Most of nevi do not change over one year. Monitoring over intervals longer than one year is not recommended.
- The longer the monitoring period, the more noticeable the changes are.
- An Atlas of DermoscopyDermoscopy is a non invasive diagnostic method., Second Edition. Marghoob A. et al. CRC Press; 2012.
- Altamura, D., Avramidis, M. & Menzies, S.W., 2008, Assessment of the optimal interval for and sensitivity of short-term sequential digital dermoscopyDermoscopy using digital images. This is used for telemedicine and monitoring. moni- toring for the diagnosisis the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines with variations in the use of logic, analytics, and experience to determine "cause and effect". In systems engineering and computer science, it is typically used to determine the causes of symptoms, mitigations, and solutions of melanoma. Arch Dermatol, 144, 502–6.
- Altamura, D., Zalaudek, I., Sera, F., et al., 2007, Dermoscopic changes in acralAcral melanoma is a type of skin cancer that occurs on fingers, palms, soles, and nail beds. mela- nocytic nevi during digital follow-up. Arch Dermatol, 143, 1372–6.
- Argenziano, G., Kittler, H., Ferrara, G., et al., 2010, Slow-growing melanoma: a dermoscopyDermoscopy is a non invasive diagnostic method. follow-up study. Br J Dermatol, 162, 267–73.
- Argenziano, G., Zalaudek, I. & Ferrara, G., 2007, Fast-growing and slow-growing melanomas. Arch Dermatol, 143, 802–3; author reply 803–4.
- Banky, J.P., Kelly, J.W., English, D.R., Yeatman, J.M. & Dowling, J.P., 2005, Incidence of new and changed nevi and melanomas detected using baseline images and dermoscopy in patients at high risk for melanoma. Arch Dermatol, 141, 998–1006.
- Bauer, J., Blum, A., Strohhäcker, U. & Garbe, C., 2005, Surveillance of patients at high risk for cutaneous malignantThis glossary term has not yet been described. melanoma using digital dermoscopy. Br J Dermatol, 152, 87–92.
- Dawid, M., Pehamberger, H., Wolff, K., Binder, M. & Kittler, H., 2002, Evaluation of the ability of patients to identify enlarging melanocytic nevi. Arch Dermatol, 138, 984–5.
- Fuller, S.R., Bowenalso known as squamous cell carcinoma in situ is a neoplastic skin disease. It can be considered as an early stage or intraepidermal form of squamous cell carcinoma. It was named after John T. Bowen, G.M., Tanner, B., Florell, S.R. & Grossman, D., 2007, Digital dermoscopic monitoring of atypical neviNevi that clinically look like melanoma but that histopathologically are not melanomas in patients at risk for melanoma. Dermatol Surg, 33, 1198–206; discussion 1205–6.
- Haenssle, H.A., Krueger, U., Vente, C., et al., 2006, Results from an observational trial: digital epiluminescence microscopy follow-up of atypical nevi increases the sensitivity and the chance of success of conventional dermoscopy in detecting melanoma. J Invest Dermatol, 126, 980–5.
- Kittler, H. & Binder, M., 2001, Risks and benefits of sequential imaging of melanocytic skin lesions in patients with multiple atypical nevi. Arch Dermatol, 137, 1590–5.
- Kittler, H. & Binder, M., 2002, Follow-up of melanocytic skin lesions with digital dermoscopy: risks and benefits. Archives of Dermatology, 138, 1379.
- Kittler, H., Guitera, P., Riedl, E., et al., 2006, Identification of clinically featureless incipient melanoma using sequential dermoscopy imagingThis glossary term has not yet been described.. Arch Dermatol, 142,
- Kittler, H., Pehamberger, H., Wolff, K. & Binder, M., 2000a, Follow-up of melanocytic skin lesions with digital epiluminescence microscopy: patterns of modifications observed in early melanoma, atypical nevi, and common nevi. J Am Acad Dermatol, 43, 467–76.
- Kittler, H., Seltenheim, M., Dawid, M., et al., 2000b, Frequency and characteristics of enlarging common melanocytic nevi. Arch Dermatol, 136, 316–20.
- Menzies, S.W., Gutenev, A., Avramidis, M., Batrac, A. & McCarthy, W.H., 2001, Short-term digital surface microscopic monitoring of atypical or changing melanocytic lesions. Arch Dermatol, 137, 1583–9.
- Robinson, J. & Nickoloff, B., 2004, Digital epiluminescence microscopy monitoring of high-risk patients. Arch Dermatol, 140, 49–56.
- Schiffner, R., Schiffner-Rohe, J., Landthaler, M. & Stolz, W., 2003, Long-term dermoscopic follow-up of melanocytic naevi: clinical outcome and patient compliance. Br J Dermatol, 149, 79–86.
- Terushkin, V., Dusza, S.W., Scope, A., et al., 2012, Changes observed in slow-growing melanomas during long-term dermoscopic monitoring. Br J Dermatol, 166, 1213–20.
- Zalaudek, I., Karin, S., Marghoob, A., et al., 2011, Frequency of dermoscopic nevus subtypes by ageprocess of becoming older and body sitedescribes the area of the body: a Cross-sectional Study. Arch Dermatol, 147, 663–70.